Effective nutritional management is crucial to the health of people with swallowing difficulties.
I would like you to imagine that, following a stroke you are unable to chew or swallow food and drink normally or to safely pass liquid or solid foods from your mouth to your stomach.
As a result of this, and in order to minimise the risk of you aspirating or choking, you are prescribed a texture modified diet, where your meals have to be pureed down to a smooth, moist and uniform consistency. You become increasingly dependent on carers at mealtimes to assist you, no longer are you able to enjoy dignified, independent eating, which can be both degrading and upsetting.
You are served your pureed meals either all mixed up in one bowl, where all ingredients have been pureed down together and which look colourless and smell and taste disgusting,
(I know as I have tasted this, and it made me cry.)
Or a number of coloured blobs on a plate where the individual foods have been pureed separately, at least, but are unrecognisable and unidentified, therefore you don’t know what you are eating.
It may take you longer to physically consume your meals, meaning that your food can go cold and unappetising; no one likes to eat food which has gone cold right?
How would you feel if you, or one of your loved ones, were presented with either of the above meals? Would you want to eat them?
And if your answer is no, then why would it be considered acceptable to present these meals to people with Dysphagia?
After all, we all eat with our eyes first.
You could easily lose your appetite and not want to eat meals presented in this way, resulting in weight loss, depression and anxiety, or fear at mealtimes which can exacerbate malnutrition. Secondary complications could include constipation, poor wound healing, increased susceptibility to infection and impaired muscle function.
Supporting ladies and gents with Dysphagia and ensuring that they maximise on the correct levels of nutrition and hydration represents a huge challenge to care managers, and their teams, given that these residents are at high risk of being deficient due to consistently having to eat an altered consistency of meals, which can offer less nutritional value, and finding it difficult to tolerate large volumes of fluids.
Dysphagia is known to affect between 53%-74% of nursing home residents. It may occur in people who have a Dementia, stroke, motor neurone disease and other neurological conditions.
Here are our top tips to help you support people with Dysphagia achieve optimal nutrition and hydration.
1. Oral Health
Good oral hygiene is really important as any oral pain can make chewing difficult and uncomfortable.
Make sure that dentures are correctly fitted.
A healthy diet can help to keep the mouth healthy - to help maintain adequate nutrition and keep teeth and gums healthy, older adults need to continue to eat enough foods each day which contain calcium, protein and other essential nutrients.
Oral health is an essential requirement to enable a good chewing function, which may impact on food choices and nutritional well-being.
Good oral hygiene and oral care, which are different, will give better patient outcomes and improve nutritional intake and hydration.
Oral hygiene: brushing teeth and cleaning the oral cavity using a toothbrush and paste.
- Oral care: delivered every 2 hours, perhaps when repositioning
- Ensuring the mouth is clear of trapped foods and debris
- Ensuring the mouth is clean and moist
- Checking that the oral environment hasn’t altered
- Interacting – asking people how their mouth feel, are they experiencing any pain? Does it feel dry?
2. Assisting A Person At Mealtimes
Ensure the person is alert and sitting upright before offering food and drink.
Gently rubbing their cheek or neck may help to prompt them to swallow.
If, due to their condition they are slow eaters, consider the use of a keep warm plate or bowl to help keep their meals warmer and more palatable for longer.
3. Fortification Of Meals
A texture-modified diet should ideally meet the recommended daily allowance of energy, protein and micronutrients for a meal. However, due to poor nutrient density, high dilution factor and limited palatability, modified consistency meals are known to result in significant weight loss. In view of difficulties in achieving an adequate nutritional intake from a modified consistency diet alone, food fortification may be necessary.
Choose liquids to added to pureed/semi-solid foods with nutritional value such as broth, juice or milk, rather than water.
Higher calorific additions such as full fat milk, cream, butter and sauces provide extra protein, energy and calcium.
4. Meal Presentation
For people on a pureed diet particularly, meal presentation is as fundamental as the dish itself. We all eat with our eyes and it is common for people with a Dementia to refuse to eat what they can’t recognise.
It’s so important to ensure that food always look appetising and is attractively presented using colour and contrast on the plate for everyone, regardless of their condition so that no one is isolated or treated differently.
The clever use of food moulds is an increasingly popular tool to help recreate the original shapes of pureed foods as family members and care caterers understand their key benefits:
- Improved meal presentation and nutrition
- Increased dignity and enjoyment at mealtimes
- Greater meal variety
- Reduced preparation time and wastage
"what is most important is that my daughter is beginning to enjoy her meal times and showing greater independence .... because of the moulded food. From my experience, the silicon food moulds have been a success." - testimonial from a customer supporting her daughter with Down's syndrome, oral dysphagia, autism, sensory processing disorder and food intolerances.
5. The Use Of Food Thickeners
Food thickeners are used to thicken liquids and foods to various consistencies, helping to slow the transit of foods and fluids to allow more time to coordinate the swallowing process safely, thus preventing food and fluid entering the lungs and causing serious complications including chest infections and death due to choking or aspirational pneumonia.
They are added to pureed foods prior to placing in the food moulds to help retain the food shape and to create the appealing finish.
Regular staff training should take place to ensure that the correct volume and amount of thickener is used for both foods and fluids, to ensuring safe and acceptable consumption for the resident.
6. Varying The Menus
The more varied and interesting the menu choices are for residents on pureed diets the greater chance of increased acceptability of foods and nutritional intake. Take a look at this article with recipe ideas to recreate yourself.
7. Training - A Whole Team Effort
Where I have witnessed the best success stories for improving mealtime experience for residents with Dysphagia is where the whole team including management, care staff and catering teams have all embraced the concept of ‘why we want to achieve this’ to ensure continued and sustainable improvements.
We have teamed up with experienced and passionate care industry chef/trainers to bring you a range of training packages, email for more information. to help educate and inspire care teams to deliver better outcomes for the people they support with Dysphagia.
Summary
Effective nutritional management is crucial to the health of people living with dysphagia. Appropriate and timely nutritional intervention can play a vital role in the prevention of dehydration, malnutrition and promotion of recovery.
Please contact us if you would like to learn more details on the training packages available of if you would like to download your FREE copy of our unique and innovative Dignified Dining Solutions Guide which has been produced with the sole intention of helping people with Dementia to eat better and includes more information on managing Dysphagia.
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